How Medical Underwriting Affects Your Health Insurance

Navigating the world of personal insurance can feel overwhelming, especially when faced with terms and processes unfamiliar to the average person. Medical underwriting often stands out as particularly confusing for many. However, medical underwriting is an essential part of the health insurance industry, which can impact your eligibility for coverage or the cost of your premiums.

At its core, medical underwriting is a mechanism that insurers like us at Saskatchewan Blue Cross use to evaluate the risks associated with covering an individual. Through this evaluation process, insurance companies assess risk to determine eligibility for coverage, if there are any benefits that should be excluded from your insurance policy, and how much you should pay in premiums.  As a person applying for insurance, it’s helpful to understand the nuances of medical underwriting so you can make an educated decision about the best plan to fit your needs. 

Empower yourself

The journey of seeking and securing health insurance might feel like it’s full of obstacles for those with pre-existing conditions or specific cost risk factors. Saskatchewan Blue Cross recognizes these challenges and emphasizes the importance of potential policyholders understanding the medical underwriting so you can make an informed choice about the best plan for you. 

For those who have previously encountered difficulties, grasping the details of medical underwriting isn’t just about deciphering industry jargon. Knowledge helps you empower yourself to take proactive steps toward securing the health insurance you need and achieve peace of mind with comprehensive coverage.

What is a medical underwriter?

The medical underwriter is an insurance professional who stands at the intersection of health care, statistics, and finance. The underwriter will collect the necessary information and analyze a specific case for its specific needs.

Medical underwriting is where insurers evaluate risks associated with providing health coverage to an individual. It forms the foundation of how insurance premiums are decided and how coverage is extended or denied.

How underwriting works

Imagine a tightrope walker. The rope’s tension and height represent a person’s various health risks. The medical underwriter is an expert evaluating how well the walker might safely cross the rope based on training, past performances, and conditions on the day of the performance. 

Drawing this parallel, a health insurance underwriter looks at a person’s medical background and assesses current and chronic conditions, the type of treatment required, and the current status of any known conditions.  Putting all this information together, they determine potential health risks and decide on premium rates or coverage eligibility.

How underwriters assess risk

The role of a medical underwriter is heavily data-driven, and an underwriter will employ a range of tools and sources to make decisions. Comprehensive medical histories, detailed doctors’ reports, lab results, and even lifestyle choices can be considered. An underwriter evaluates the likelihood of a future claim by analyzing this information and comparing it to known statistics about medical outcomes. 

Think of it like weather forecasting. Meteorologists don’t predict rain based on a hunch; they use data, patterns, and models. Similarly, suppose the data suggests a person has a higher likelihood of health issues, like a meteorologist predicting a storm is on its way. In that case, you could be paying higher insurance premiums, have specific exclusions applied, or, in rare instances, be denied coverage.

Tools of the medical underwriter

Underwriters use various tools depending on individual needs. They may request an attending physician statement, which summarizes your medical history and is verified by a third party. They may ask you to provide a copy of medical reports, blood work, or urinalysis depending on your medical history.

A medical underwriter may conduct a telephone interview to ask further questions about the medical history you’ve provided. 

Judgments and decision-making

When a medical underwriter makes a decision about your case,  it can be easy to feel frustrated with the medical underwriting process. However, underwriters operate within the confines of long-established guidelines and standards of data gathering and analysis. Their findings are based, for a large part, on actuarial tables.

Actuarial tables are used by underwriters to look up probabilities based on vast sets of historical data. These tables are constantly updated as new information becomes available and can provide statistical probabilities of various health events based on demographics, health histories, and more. When an underwriter makes a decision, it’s grounded in data and analysis, ensuring fairness and accuracy in the evaluation process.

The role of a medical underwriter is pivotal in the insurance industry, bridging the gap between individual cases and the financial requirements of insurance policies. Their data-driven, systematic approach ensures the insurance framework remains sustainable, fair, and reflective of personal health risks.

Factors considered in medical underwriting

Medical underwriting ensures premium rates are set fairly and reflect the associated risks of covering any given individual. While this may sound straightforward, the process is intricate, involving many factors based on someone’s health and lifestyle. These details collectively form a comprehensive profile, guiding insurers in their decision-making process.

Pre-existing conditions

Arguably, the most influential factor in the medical underwriting process is the presence of pre-existing conditions. A pre-existing condition refers to any medical ailment, disorder, or disease that an individual was diagnosed with or treated for before they applied for a new insurance policy. Underwriters may also consider undiagnosed conditions based on the combination of your symptoms and the treatment you may be undergoing.

Examples of such conditions are numerous and varied, like diabetes requiring ongoing medication and management, heart diseases requiring surgeries and long-term care, or conditions like cancer, whose treatment can be lengthy and potentially recurrent.

Suppose an individual already has a known health condition. In that case, there’s a higher statistical likelihood they’ll require medical intervention or care in the future, which in turn means a higher probability of insurance claims. 

For the insurance company, this situation represents a higher financial risk, and, as a result, policies for individuals with significant pre-existing conditions might come with higher premiums or specific exclusions to offset this increased risk.

Lifestyle factors

Beyond the realm of medical history lies the domain of personal lifestyle choices, which can profoundly impact health and, by extension, insurance premiums. Some lifestyle factors are universally recognized as high-risk behaviours, and higher risks mean higher premiums. 


Age is a prime consideration in medical underwriting. As people age, they naturally become more susceptible to a variety of health issues, meaning older adults typically face higher premiums.

While it can seem clinical and impersonal, medical underwriting is a carefully considered process aiming to strike a balance between ensuring the sustainability of the insurance industry and providing fair coverage opportunities for individuals.

You and medical underwriting

Navigating the labyrinth of health insurance might seem challenging. Medical underwriting is an integral aspect of how insurance policies are crafted, and knowing how it works can help you decide on the right plan for you.   

Be informed

The first step to navigating through medical underwriting is education. Understanding the nuances of what underwriters seek and how they evaluate applications can give you helpful guidance on how to choose the right plan for your needs. For example, if you know you have a pre-existing condition that might impact your eligibility for insurance coverage, consider choosing a plan like Guaranteed Acceptance, which provides coverage with no medical questionnaire required. 

Prioritize your health and well-being

While you can’t change the past, focusing on the present can impact future outcomes. Your current health status and lifestyle choices are paramount in the underwriting process.

Commit to regular exercise for improved physical health and mental well-being. A balanced diet, rich in nutrients, ensures your body gets the sustenance it needs to function optimally. Moreover, certain lifestyle habits, like tobacco and alcohol, can raise red flags during underwriting. Remember, a healthier you is a more insurable you.

Seek expert guidance

While the world of insurance can be intricate and complex, you don’t have to navigate it alone. Enlisting the assistance of experts, like Saskatchewan Blue Cross, can make all the difference. 

With our in-depth industry knowledge, we can provide valuable insights and suggest the best plan to align with your needs. 

Finding what works for you

While medical underwriting might sound foreboding, it’s merely a mechanism to ensure the insurance system remains sustainable and fair. By being informed, focusing on leading a healthy lifestyle, and leveraging the expertise of organizations like Saskatchewan Blue Cross, you can find health coverage that offers the right benefits to suit your needs.

If you have a pre-existing medical condition or are concerned that other elements of your medical history might impact your ability to get health insurance coverage, Saskatchewan Blue Cross can help. The Guaranteed Acceptance plan offers health coverage with no exclusions, and no waiting periods, no medical underwriting required. Learn more about Guaranteed Acceptance here, or send us a message using our Contact Us form

The journey to securing comprehensive health insurance might have its hurdles, but they’re manageable. Empower yourself with knowledge, be proactive in your approach, and lean on the wisdom of industry experts. 

Health insurance isn’t just a policy; it’s a promise of protection. Contact Saskatchewan Blue Cross today to start your health insurance journey.